MEDICARE: DR. JOHN LINDER WATSTEIN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5812	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5812	OTHER	MD	BOARD OF DENTAL EXAMINERS

General Provider Information

NPI Number	:	1366580078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN LINDER WATSTEIN DDS

Provider Business Mailing Address
First Line	:	10905 FORT WASHINGTON ROAD
Second Line	:	SUITE #407
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5807
Country	:	US
Telephone Number	:	301-292-6220
Fax Number	:	301-292-6228

Provider Business Practice Location Address
First Line	:	10905 FORT WASHINGTON ROAD
Second Line	:	SUITE #407
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5807
Country	:	US
Telephone Number	:	301-292-6220
Fax Number	:	301-292-6228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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